Day 58

5.03: The unravelling tapeworm of a question about buying people’s kidneys off them and hawking them among the sick and needy just won’t, it seems, go away.

Yet again and quite rightly, Sally Satel pointed out last weekend that, “as the number of renal transplant operations [in the US] remains mired between 16,000 and 17,000 a year, the number of candidates on the waiting list mounts.”

Quite rightly too, she says that, as well as being life-saving, transplants are far cheaper than keeping people going with tubes and fax machines on dialysis.

But still she’s got this bee in her bonnet, throbbing about her arteries like an aneurysm: “The only realistic long-term solution to the kidney shortage in the United States is to allow some form of donor compensation.”

A transplant recipient herself, Satel is also a psychiatrist: she’s got a better grounding in science than me. So my little brain starts palpitating trying to fathom how she has the half-arsed front (can front be half- or any kind of arsed?) to agitate for the medical profession’s adopting a practice which even a bozo like me can see is ethically questionable and evidentially unsubstantiated.

There’s an iceboxful of ethical objections to cash for kidneys, the most noisily trumpeted being: “won’t it just become a big speakeasy where rich folk people cut open their wallets and pay through the nose to sup essence of the poor?”

I think there’s a bigger hedge to clear before we reach that water jump: the stripey fence of informed and freely-given consent. How can a decision to donate an organ be truly said to have been taken without coercion if the outcome of that decision has implications for the future wealth of the donor?

Shut up; it can’t.

Then there’s that trifling scientific fuss about stitching together a shred or two in evidence. Presumably someone awfully clever (and independently funded) has looked into whether incentivisation programmes actually do help increase the supply of organs.

I’m guessing those be-goggled chaps have compared their results with the likely upswing in kidney flow from bright ideas like opt-out donation, pooled donation, and targeted education for groups with the worst shortages? There’s sophisticated, peer-reviewed data modelling, isn’t there?

There must be some evidential basis for this, mustn’t there? She’s a doctor after all. Surely to God she’s got a pie chart or two.

Well, I don’t know what I’m talking about. But nor, apparently, does Sally Satel, which I why I woke up in a bad mood. I shall be funnier tomorrow, I promise, with far less steam expressing from the ears.

6.48: Less rampaging progress this morning than the past two days, but we’ve hobbled to the end of another chapter. Hobble on; hobble on.